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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 315002841
Report Date: 02/08/2023
Date Signed: 02/13/2023 09:39:49 AM


Document Has Been Signed on 02/13/2023 09:39 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926



FACILITY NAME:AUBURN VALLEY SENIOR LIVINGFACILITY NUMBER:
315002841
ADMINISTRATOR:DOCMANOV, ANAMARIAFACILITY TYPE:
740
ADDRESS:3800 LORAY LANETELEPHONE:
(916) 757-7057
CITY:AUBURNSTATE: CAZIP CODE:
95602
CAPACITY:6CENSUS: 6DATE:
02/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Magda SzantoTIME COMPLETED:
12:30 PM
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On 2/8/2023 LPA Tryon visited the home to do an annual visit. LPA met with staff Magda Szanto. LPA spoke with licensee Ana Docmonov by phone.
LPA reviewed the Infection Control Domain with Mrs. Docmonov and Ms, Szanto. The facility appears to be in compliance with Infection Control policies.

LPA toured the facility including common areas, kitchen, food supplies, laundry, medication area, bedrooms, bathrooms, hallways. The facility is clean, in good condition and well-furnished.
Food supplies are adequate to meet the requirement of 2 days perishable and 7 days non-perishable. The facility has a good supply of PPE, hand sanitizer, soaps, paper products,etc.

Appropriate postings including COVID posters, regular posters such as client's rights, reporting agencies, emergency plans, etc. are present.

At this time, the facility appears to be in substantial compliance with the regulations. No deficiencies cited.
Exit interview conducted.
SUPERVISOR'S NAME: Troy OrdonezTELEPHONE: (916) 263-4832
LICENSING EVALUATOR NAME: Todd TryonTELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:
DATE: 02/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/08/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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